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Lithium and CHF
alburden3 posted:
I'm not sure if this is the right place to post this question, but it's worth a shot.

I have recently been put on lithium - which is working wonderfully for me - but I have a history of congestive heart failure. With CHF, I have to watch my sodium intake and I know that you have to watch your sodium levels. Should I be concerned that the sodium levels in the lithium will aggrevate the CHF? Should I talk to my psychiatrist about this?

Any thoughts or suggestions would be greatly appreciated.
mozzergurl responded:
Maybe Dr. Goldberg can answer this for you... Did you bring this up to your psychiatrist or pcp?
The Sanest Days Are Mad... - Morrissey
alburden3 replied to mozzergurl's response:
No, I haven't. I didn't think about the fact that I already have to watch my sodium intake because of the CHF when my psych told me to watch my sodium intake. I'm scared to keep taking it, but it's working so well for me. I have a psychiatrist appointment on Tuesday... should I bring this up? I don't think she remembers about the CHF.
Anneinside replied to alburden3's response:
Absolutely bring it up. It is important for your health and emotional well-being.
ddnos replied to alburden3's response:
Hi Alburden3, your pdoc should have known that you have a history of congenital heart failure, and if he/she did, then I would think (hope) he/she would have taken that into consideration when prescribing lithium to you. If your pdoc doens't know this aout you, then I would absolutely let him/her know and ask if it's Ok that you take lithium. I have NO idea if lithium would be an issue for you or not, but your doctor would, or at least definately should! Talk with your doc! I've been on lithium for 20 years and it works wonders for me, but I don't have a history of CHF, so I can't speak to that other than talk with your doctor.

Forgiveness is letting go of the hope that the past could have been any different --Unknown
Joseph F Goldberg, MD responded:
Dear Alburden3,

All doctors people see should know all of the medicines they are taking -- usually they proactively ask, but if for some reason they don't, be sure to update them (that goes for psychiatrists, dermatologists, eye doctors, dentists....). Having a history of congestive heart failure does not mean someone can't take lithium, but you are correct that if your internist has you limiting your salt (sodium) intake, then your kidneys might compensate for low sodium intake by holding on to more lithium and excreting less than would otherwise be the case...which means that lithium levels could be higher, which means that dosing might wisely be kept on the lowish side. Lithium levels and kidney tests are usually checked every 6 to12 months when everything is stable but your psychiatrist might want to keep a closer eye on these labs to make sure your lithium level remains in a stable and safe place given your sodium intake restrictions. (Lithium and sodium are each salts; one does not contain the other. Your kidneys retain salt in your bloodstream as blood passes through the kidneys to make urine. If someone is not taking in much sodium -- as, for instance, when told to restrict sodium intake because it could raise blood pressure -- then your kidneys will happily reabsorb more lithium into your system to compensate for the low sodium. This is why in general people who take lithium are advised not to skimp on make sure lithium levels don't rise too high as a result of low sodium intake.)

Hope this helps.

- Dr. G.

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Joseph F. Goldberg, MD, is a Clinical Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. He also maintains a private prac...More

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